Psychosocial Factors and Cancer - UCLA Stress Lab

Cite as: Lamkin, D. M., & Slavich, G.
M. (2014). Psychosocial factors and
cancer. In H. L. Miller (Ed.),
Encyclopedia of theory in psychology.
Thousand Oaks, CA: Sage Publications.
Available at: www.uclastresslab.org

Psychosocial Factors and Cancer

Donald M. Lamkin and George M. Slavich

Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral
Sciences, University of California, Los Angeles, CA 90095

Psychological and social aspects of life, which that stem from abnormal immune cells in the
have been collectively called psychosocial body’s lymphatic vessels; finally, leukemias
factors, have long been known to play an are cancers that stem from malignant
influential role in shaping physical health and immune cells in blood (i.e., white blood cells)
disease. Included in this relatively broad or other blood-forming cells that occupy the
bone marrow. All told, the National Cancer
“umbrella” term are processes that involve a Institute currently recognizes the existence of
person’s mental state, psychological more than 100 distinct cancers that can occur
tendencies, and surrounding social in the human body.
environment. Some examples of psychosocial
An association between psychosocial
factors include acute stress, chronic stress, factors and cancer has been pondered at
coping, perceived control, neuroticism, least since the 2nd century. At that time the
hostility, anxiety, rumination, hopelessness, Greek physician, Claudius Galen, believed that
women with a depressed or “melancholic”
negative affect, depression, social class, social disposition were more prone to getting
conflict, social isolation, self-efficacy, and self- cancer. When examined prospectively over
esteem. This article provides an overview of time, the majority of modern research
research on psychosocial factors and cancer. suggests that no reliable link exists between
psychosocial factors and cancer incidence –
More specifically, it summarizes different that is, the onset of cancer. However, a
types of cancer, known associations between growing body of research shows that stress-
psychosocial factors and cancer, biological related psychosocial factors play a role in
cancer progression – that is, the rate at which
pathways that link psychosocial factors and an existing cancer in the body worsens or
cancer, and psychosocial interventions that causes mortality. In this latter regard, studies
have been shown to alter these biological of breast cancer are by far the most common.
processes and improve clinical outcomes. This research has shown that several
psychosocial factors including psychological
Cancer is not a singular disease. Rather, distress, anxiety, hostility, lack of emotional
cancer is a term that describes a group of expression, low overall quality of life, and
diseases that, while similar in gross
Corresponding Author:
phenotype, are quite heterogeneous in
etiology and pathophysiology. Cancers are George M. Slavich, Ph.D., Cousins Center for
broadly categorized according to the type of Psychoneuroimmunology, University of California,
tissue in the body where they originate. Los Angeles, UCLA Medical Plaza 300, Room 3156,
Los Angeles, CA 90095-7076, USA
Cancers that originate in epithelial cells – that E-mail: [email protected]
is, cells that line the outer surface of an
organ, such as skin cells – are called
carcinomas and are the most prevalent;
sarcomas are cancers that originate in the
connective or supportive tissues of the body
(e.g., bone, muscle); lymphomas are cancers

Lamkin & Slavich 2

poor familial and romantic relationship quality inflammation. Inflammation, in turn, is known
are associated with shorter survival time in to be involved in tumor growth, as well as in

breast cancer patients. The nature of this promoting several distressing symptoms that
relationship is complex, though, as some at least some cancer survivors experience,
studies have found that low quality of social such as fatigue, depression, difficulty
support, higher anxiety, and higher hostility concentrating, increased pain sensitivity, and
are associated with better survival rates.
social-behavioral withdrawal. The exact
Associations between psychosocial factors mechanisms that link psychosocial factors with
and clinical outcomes has been examined in inflammation and other tumor promoting

other cancers as well, including lung cancer, physiology are still being elucidated, and this
colorectal cancer, immune cell cancers, skin research is being conducted using a
cancers, female reproductive cancers (e.g. combination of methods that include clinical
ovarian cancer, cervical cancer, uterine populations, pre-clinical animal models, and
basic in vitro techniques.
cancer), prostate cancer, stomach cancer,
liver cancer, head and neck cancer, and brain Some of the most potentially important
cancers. In studies that have examined lung work on psychosocial factors and cancer has

cancer progression, personality factors such focused on developing interventions that can
as defensiveness and anger suppression or impact psychosocial and biological pathways to
repression, which has been called improve clinical outcomes. A landmark
“antiemotionality,” and other psychosocial randomized controlled trial (RCT) that began in

factors such as psychological distress and the late 1970s showed that 12 months of
poorer quality of life have been shown to weekly group-based supportive expression
predict shorter survival time. In studies of therapy extended the survival of breast cancer

immune cell cancers, depressive mood, patients by 2-fold after 10 years of follow-up.
depressive coping styles, psychological Since then, two additional RCTs have
distress, poor social support, and poor quality examined the effect of psychosocial

of life have been found to predict shorter interventions on clinical outcomes in cancer, as
survival time. Fewer progression studies exist well as psychological adaptation to having the
for each of the other cancers listed above and disease and biological processes that are
the results of these studies are more mixed. relevant for its progression. The first of these

A key question on the topic of psychosocial studies randomly assigned melanoma patients
factors and cancer involves how exactly to 6 weeks of group-based therapy that
psychosocial factors impact clinical outcomes focused on problem-solving skills, stress

in this disease. This is a complicated issue, management, and psychological support
given that many different psychosocial factors versus a standard care control group. During
have been implicated in cancer and, in the 10 years of follow-up, the experimental
addition, many different types of cancer exist. group showed less negative mood, more

Nevertheless, some consensus has emerged immune system processes that inhibit disease
suggesting that psychosocial factors impact progression, and lower rates of cancer
clinical outcomes in cancer at least in part by recurrence and mortality. A second study

influencing activity of the autonomic nervous, randomized breast cancer patients to 4 months
endocrine, and immune systems. More of weekly group-based therapy followed by 8
specifically, psychosocial factors that involve months of monthly group-based therapy that
negative affectivity and social stress are focused on reducing stress, improving mood,

thought to activate two of the body’s main altering health behaviors, and maintaining
stress systems – namely, the sympathetic adherence to cancer treatment. During 11
nervous system and the hypothalamic- years of follow-up, the experimental group

pituitary-adrenal axis, which affect showed less distress, more immune system
components of the immune system involved in processes that inhibit disease progression, and

Lamkin & Slavich 3

less cancer recurrence and mortality. In
conclusion, then, there is evidence that
psychosocial factors influence biological and
clinical outcomes in cancer, and that certain
psychosocial interventions can impact these
processes and yield positive effects.

Further Readings

Antoni, M. H., Lutgendorf, S. K., Cole, S.W.,
Dhabhar, F. S., Sephton, S.E., McDonald,
P. G., Stefanek, M., & Sood, A. K. (2006).
The influence of bio-behavioural factors
on tumour biology: Pathways and
mechanisms. Nature Reviews Cancer, 6,
240-248.

Antoni, M. H. (2013). Psychosocial
intervention effects on adaptation,
disease course and biobehavioral
processes in cancer. Brain, Behavior, and
Immunity, 30, S88-S98.

Chida, Y., Hamer, M., Wardle, J., & Steptoe,
A. (2008). Do stress-related psychosocial
factors contribute to cancer incidence
and survival? Nature Reviews Clinical
Oncology, 5, 466-475.

Hanahan, D., & Weinberg, R. A. (2011).
Hallmarks of cancer: The next
generation. Cell, 144, 646-674.

Nausheen, B., Gidron, Y., Peveler, R., &
Moss-Morris, R. (2009). Social support
and cancer progression: A systematic
review. Journal of Psychosomatic
Research, 67, 403-415.